Alteraciones electrolíticas y del metabolismo en pacientes con diabetes mellitus y enfermedad renal crónica. Parte 1 / Electrolyte and metabolism alterations in patients with diabetes mellitus and chronic kidney disease. Part 1

En el paciente con diabetes mellitus (DM) y enfermedad renal crónica (ERC), las alteraciones electrolíticas y metabólicas constituyen un verdadero desafío. En noviembre de 2021, el Comité de Nefropatía de la Sociedad Argentina de Diabetes realizó una jornada científica con el objetivo de actualizar las alteraciones hidroelectrolíticas y del metabolismo óseo mineral, y las consideraciones dietarias en ERC y DM.

In patients with diabetes mellitus (DM) and chronic kidney disease (CKD), electrolyte and metabolic alterations constitute a real challenge. In November 2021, the Nephropathy Committee of the Argentine Diabetes Society held a scientific conference with the aim of updating hydroelectrolytic and mineral bone metabolism disorders, and dietary considerations in CKD and DM.

Jornadas del Comité de Nefropatía de la Sociedad Argentina de Diabetes. Actualización de cirugía bariátrica en paciente con diabetes y enfermedad renal. Parte 2 / Conference of the Nephropathy Committee of the Argentine Diabetes Society. Bariatric surgery update in a patient with diabetes and kidney disease. Part 2

La prevalencia de obesidad y diabetes mellitus se asocia al desarrollo de enfermedad renal crónica y estadios terminales de la misma. En individuos con obesidad se produce un mecanismo de hiperfiltración, probablemente compensatorio para satisfacer la alta demanda metabólica asociada al aumento del peso corporal, con la presencia de proteinuria en individuos sin enfermedad renal. La histopatología muestra una glomeruloesclerosis focal y segmentaria relacionada con la obesidad en un marco de glomerulomegalia. La cirugía metabólica es el medio más efectivo para obtener una pérdida de peso sustancial y persistente. Se ha demostrado la superioridad de la cirugía sobre el tratamiento médico no solo para lograr un mejor control glucémico, sino también para la reducción de los factores de riesgo cardiovascular. Los mecanismos parecen extenderse más allá de la magnitud de la pérdida de peso e incluyen mejoras tanto en los perfiles de incretinas como en la secreción y la sensibilidad a la insulina. El Comité de Nefropatía de la Sociedad Argentina de Diabetes realizó esta revisión sobre los mecanismos involucrados en la obesidad como causa de enfermedad renal o empeoramiento de la misma por diabetes, y los mecanismos a través de los cuales la cirugía bariátrica beneficiaría a los pacientes con diabetes y enfermedad renal crónica en todos los estadios de la misma, así como los controles pre y posquirúrgicos en este tipo de cirugías.

The prevalence of obesity and diabetes mellitus are associated with the development of chronic kidney disease and its terminal stages. In individuals affected by obesity, a probably compensatory hyperfiltration mechanism occurs to satisfy the high metabolic demand associated with increased body weight; it is also associated with the presence and development of proteinuria in individuals without kidney disease. Histopathology shows obesity-related focal and segmental glomerulosclerosis in a setting of glomerulomegaly. Metabolic surgery is the most effective means of obtaining substantial and lasting weight loss. The superiority of surgery over medical treatment has been demonstrated only to achieve better glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms appear to extend beyond the magnitude of weight loss and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. The Nephropathy Committee of the Argentine Diabetes Society carried out this review on mechanisms involved in obesity as a cause of kidney disease or worsening of kidney disease due to diabetes, the mechanisms by which bariatric surgery would benefit patients with diabetes and kidney disease chronic and its terminal stages, the pre and post-surgical controls that should be performed by patients undergoing this type of surgery

Jornadas del Comité de Nefropatía de la Sociedad Argentina de Diabetes. Actualización de cirugía bariátrica en paciente con diabetes y enfermedad renal. Parte 1 / Conference of the Nephropathy Committee of the Argentine Society of Diabetes. Bariatric surgery update in a patient with diabetes and kidney disease. Part 1

La prevalencia de obesidad y diabetes mellitus se asocia al desarrollo de enfermedad renal crónica y estadios terminales de la misma. En individuos con obesidad, se produce un mecanismo de hiperfiltración, probablemente compensatorio para satisfacer la alta demanda metabólica asociada al aumento del peso corporal, con la presencia de proteinuria, en individuos sin enfermedad renal. La histopatología muestra una glomeruloesclerosis focal y segmentaria relacionada con la obesidad en un marco de glomerulomegalia. La cirugía metabólica es el medio más efectivo para obtener una pérdida de peso sustancial y persistente. Se ha demostrado la superioridad de la cirugía sobre el tratamiento médico no solo para lograr un mejor control glucémico, sino también para la reducción de los factores de riesgo cardiovascular. Los mecanismos parecen extenderse más allá de la magnitud de la pérdida de peso e incluyen mejoras tanto en los perfiles de incretinas como en la secreción y la sensibilidad a la insulina. El Comité de Nefropatía de la Sociedad Argentina de Diabetes realizó esta revisión sobre los mecanismos involucrados en la obesidad como causa de enfermedad renal o empeoramiento de la misma por diabetes, y los mecanismos a través de los cuales la cirugía bariátrica beneficiaría a los pacientes con diabetes y enfermedad renal crónica en todos los estadios de la misma, así como los controles pre y posquirúrgicos en este tipo de cirugías.

The prevalence of obesity and diabetes mellitus are associated with the development of chronic kidney disease and its terminal stages. In individuals affected by obesity, a probably compensatory hyperfiltration mechanism occurs to satisfy the high metabolic demand associated with increased body weight; it is also associated with the presence and development of proteinuria in individuals without kidney disease. Histopathology shows obesity-related focal and segmental glomerulosclerosis in a setting of glomerulomegaly. Metabolic surgery is the most effective means of obtaining substantial and lasting weight loss. The superiority of surgery over medical treatment has been demonstrated only to achieve better glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms appear to extend beyond the magnitude of weight loss and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. The Nephropathy Committee of the Argentine Diabetes Society carried out this review on mechanisms involved in obesity as a cause of kidney disease or worsening of kidney disease due to diabetes, the mechanisms by which bariatric surgery would benefit patients with diabetes and kidney disease chronic and its terminal stages, the pre and post-surgical controls that should be performed by patients undergoing this type of surgery.

Infecciones del tracto urinario en pacientes con diabetes. Parte 1 / Urinary tract infections in patients with diabetes. Part 1

Las infecciones del tracto urinario (ITUs) son frecuentes en la práctica médica diaria. Existen factores patogénicos que modulan el riesgo de su aparición que dependen del germen responsable y el huésped. La diabetes mellitus es un factor predisponente para la aparición de infecciones urinarias. Como factores de riesgo para estas infecciones se mencionan la mayor duración de la diabetes, la albuminuria y neuropatía con menor vaciamiento vesical, siendo controversial la presencia de glucosuria. Según su ubicación en el árbol urinario pueden ser bajas y altas, y de acuerdo a la severidad, complicadas o no. La bacteriuria asintomática, detectada por análisis rutinario, es más frecuente en mujeres con diabetes. La elección del esquema antibiótico en las infecciones urinarias se basa en la severidad de la infección, el antecedente de microorganismos resistentes y la sensibilidad en el antibiograma, recordando ajustar la dosis de acuerdo al grado de insuficiencia renal. En este trabajo nuestro objetivo es describir las características clínicas y el diagnóstico para un adecuado tratamiento antibiótico

Urinary tract infections (UTIs) are frequent in daily medical practice. There are pathogenic factors that modulate the risk of their onset depending on the responsible germ and host. Diabetes mellitus is a predisposing factor for developing urinary infections. The longest duration of diabetes, albuminuria and neuropathy with less bladder emptying are mentioned as risk factors for these infections, being controversial the presence of glycosuria. Depending on their location in the urinary tract, infections can be lower and upper tract infections, and according to severity, complicated or not. Asymptomatic bacteriuria, detected by routine urinalysis, is more frequent in women with diabetes. The choice of the antibiotic scheme in urinary tract infections is based on the severity of the infection, history of resistant microorganisms and sensitivity in the antibiogram, adjusting the dose according to the degree of renal insufficiency. The aim of our work is to describe the clinical characteristics and diagnosis for an adequate antibiotic treatment

Tratamiento farmacológico de la diabetes mellitus para pacientes con enfermedad renal / Pharmacological treatment of diabetes mellitus in patients with kidney disease

El manejo de la hiperglucemia en el paciente con enfermedad renal (ER) es complejo. El control estricto de la glucemia y los factores de riesgo pueden evitar la aparición y progresión de la ER; para esto es importante lograr metas glucémicas estrictas y la elección de drogas que disminuya la albuminuria y la caída del filtrado glomerular. Además en pacientes con ER debe considerarse que algunas drogas han demostrado un efecto directo sobre el riñón, más allá del descenso de la glucemia. Al momento del tratamiento, deberían tenerse en cuenta otros factores propios de la ER como mayor retención hidrosalina, riesgo cardiovascular, riesgo de hipoglucemias, mayor vida media de las drogas y el riesgo de fracturas, entre otros

Adaptación para Buenos Aires de la Escala de Orientaciones Generales de Causalidad (General Causality Orientations Scale - GCOS)* / Buenos Aires's Adaptation of General Causality Orientations Scale (GCOS)

El objetivo de este trabajo fue realizar la adaptación lingüística y estudiar las propiedades psicométricas de la Escala de Orientaciones Generales de Causalidad (General Causality Orientations Scale- GCOS) de Deci y Ryan (1985). Las orientaciones causales se refieren a la fuente de iniciación y regulación de las conductas, son relativamente estables y se relacionan con el grado de autodeterminación de las personas. Deci y Ryan postularon tres orientaciones (Autónoma, Control e Impersonal) que son medidas a través de sendas subescalas en la GCOS. Esta incluye 17 viñetas con tres ítemes cada una que se responden con una escala de 7 puntos. Participaron 184 sujetos residentes en la Ciudad de Buenos Aires y alrededores. Se solicitó el juicio de expertos para analizar el contenido de la escala y sus valoraciones coincidieron en identificar a la motivación como el constructo principal. Las evidencias de fiabilidad sugieren una apropiada consistencia interna para las tres subescalas (.76 para Autonomía, .74 para Control y .81 para Impersonal). Con respecto a la validez externa, se encontró que las medidas de síntomas psicopatológicos y de depresión variaron significativamente de acuerdo a la orientación motivacional con que se los vinculó. Además se analizaron respuestas de pares en las que se constató una concordancia importante entre la autoevaluación y la heteroevaluación en función de la profundidad del vínculo. Por último, se encontró que a medida que el nivel educativo aumentaba, disminuían las puntuaciones en Control e Impersonal.

The main objective of this work was to evaluate the psychometric properties of the GCOS in Argentinean adult population. The GCOS was originally designed in order to obtain an appropriate instrument for measuring causality orientations, that is, several aspects of people which take part in the initiation and regulation of the behavior (Deci & Ryan, 1985). It is composed by 17 vignettes which describe a situation and are followed by three responses, each one characterizes the three orientations: Autonomy, Control and Impersonal. Every item is answered on a 7-point Likert Scale, ranging from very unlikely to very likely. The GCOS was translated by three independent translators who had knowledge on Psychology to ensure the scale content validity. The content validity was assessed through the use of four independent judges who have wide knowledge on the human motivation field. Two of them suggested that the GCOS evaluated human motivation and the others recognized aspects related to power, achievement and relatedness, decision making, attribution theory. The preliminary version was tested in a small group. Some minor revisions were made on the participants' and judges' recommendations. The sample included 184 participants (106 females; 78 males). Reliability analysis showed a good internal consistency for each subscale: .76 for Autonomy, .74 for Control, and .81 for Impersonal. The item-total correlations ranged between .15 and .61 for Autonomy, .20 and .47 for Control, .15 and .54 for Impersonal. Moreover, five interviews were conducted for analyzing content validity. Five participants who obtained higher scores indifferent subscales were selected. The results showed a good consistency between the scale scores and the interview responses. Following the original study done by Deci and Ryan (1985) different scales were selected to evaluate the GCOS construct validity in our environment. The measures selected were: Autonomy - Connectedness Scale (ACS-30 - Bekker & van Assen, 1986) (Argentinean version, Brenlla & Traviganti, 2009), Beck Depression Inventory-II (BDI-II - Beck, Steer & Brown, 1996) (Argentinean version by Brenlla & Rodríguez, 2006) and, Symptom Checklist 90 Revised (SCL-90-R - Derogatis, 1994 - Argentinean version, Casullo, 2004). Significant correlations were found between the Autonomy Subscale and the SCL-90R. Particularly, it was found significant negative correlations with Depression (r = -.172; p < .05) and Psychoticism (r =- .241; p < .01). In the Control Subscale, the results showed significant correlation with BDI-II (r = .250; p < .01) and with the following factors of the SCL-R-90: Somatization (r = .249; p < .01), Obsessive-compulsive (r = .223; p < .01), Interpersonal sensitivity (r = .218; p < .05), Anxiety (r = .239; p < .01), Hostility (r = .222; p < .01), and Paranoid ideation (r = .312; p < .01). Also, negative correlations between this subscale and Factor I of the ACS-30-sensitivity to others- (r = -.207; p < .05). As regards the correlations of the Impersonal Subscale with other measures, were the clearest ones. This subscale showed significant correlations with all dimensions of SCL-R-90 (total score SCL-R-90: r = .472; p < .01) and with BDI-II (r = .389; p < .01). As well, negative correlations were found with Factor II of the ACS-30 - Capacity for managing new situations - of the ACS-30 (r = -.276; p < .01) and positive correlations with Factor III -Self-awareness (r = .238; p < .01). The sample's status characteristics influences were analyzed. No difference in scores by age and gender were found. Lastly educational biases were assessed. No influence of educational level was found in the Autonomy Subscale [F(2, 181) = .802; p = .450]. Nevertheless, as educational level decreases an increase in control and impersonal scores was found [Control: F(2, 181) = 13.748; p = .000; Impersonal: F(2, 181) = 19.767; p = .000].

Emoción y creatividad: una relación compleja / Emotion and creativity: a complex relationship

En el presente trabajo se propuso realizar una revisión bibliográfica acerca de las principales investigaciones referidas a los efectos de las emociones positivas y negativas sobre el desempeño creativo. Dado que los resultados de los estudios previos muestran ciertas discrepancias, en segundo lugar se analizaron varios modelos teóricos que han sido desarrollados con la finalidad de explicar cómo influyen las emociones sobre la cognición. Por último, se examinaron algunas variables moderadoras de la relación entre el afecto y la creatividad que pueden explicar algunas de las inconsistencias halladas (e.g. tipo de tarea realizada, nivel de activación de la emoción). En conclusión, las investigaciones analizadas parecen señalar que el estudio de las relaciones entre la creatividad y la emoción requiere de un análisis pormenorizado tanto de las características de las tareas propuestas, las particularidades de la emoción estudiada y algunas variables de personalidad que podrían moderar dicha relación.

The purpose of this research was to undertake a bibliographical survey of the main research conducted with regard to the effect of positive and negative emotions on creative performance. Because previous research -shows certain discrepancies, several theoretical models were analyzed in this study in order to understand how emotions influence cognition. Lastly, several moderators of the affect-creativity relation were examined since they can explain some of the inconsistencies found. Finally, the research analyzed seems to indicate that the study of the relationship between affect and creativity needs to conduct an in depth study of the characteristics of the tasks proposed, the specificities of the emotions which are being studied, and some dispositional variables which could moderate said relationship.

Análisis crítico del Modelo de Variación Ciega y Retención Selectiva de la Creatividad / Review of the Blind Variation and Selective Retention Model of Creativity

Se informa una revisión bibliográfica realizada acerca de uno de los modelos explicativos de la creatividad desde la teoría darwiniana, el Modelo de Variación Ciega y Retención Selectiva (Blind Variation and Selective Retention -BVSR). Este modelo se encuentra inscripto en el darwinismo secundario, el cual utiliza la teoría darwiniana metafóricamente, aplicándola a los procesos cognitivos involucrados en el proceso creativo. Uno de los principales exponentes de este modelo es Simonton (1999a, 1999b, 2005, 2007a, 2007b) quien, a partir del modelo inicialmente planteado por Campbell (1960), ha desarrollado diferentes modificaciones, ampliando sus características y alcances. El estudio realizado se propuso examinar los aportes y evidencias presentadas por Simonton al modelo de BVSR, así como también, las objeciones y críticas realizadas por algunos autores reconocidos en el área de la creatividad tales como Beghetto y Plucker (2007), Gardner (1999), Martindale (1999), Mumford y Antes (2007), Russ (1999), Sternberg (1999) y Weisberg y Hass (2007).

The main objective of this work was to examine some of the most relevant articles on the blind variation and selective retention model of creativity (BVSR) presented by Simonton (1999a, 1999b, 2005, 2007a, 2007b). The BVSR model is an explanatory model of creativity grounded in a larger theoretical framework known as secondary Darwinism. Darwinian theories of creativity can be classified in two groups (Feist, 2001; Simonton, 1999a, 2005). The first group, known as primary Darwinism or primary theories of Darwinism, is directly connected with Darwin's original formulation of biological evolution (Simonton, 2005). The principal purpose of primary theories is to understand the evolutionary processes underlying the emergence of species whose members are able to show creative behavior. In other words, primary theories attempt to explain how creative and aesthetic skills emerge in the human being, focusing the attention on the origin and evolution of those behaviors. On the other hand, Secondary Darwinism, "holds that creativity operates in a fashion analogous to the Darwinian Theory of Biological Evolution" (Simonton, 2005, p. 299). In this sense, the BVSR model of creativity applies Metaphorically the Darwinian Theory to the cognitive processes involved in creativity. Thus, the mechanisms underlying the generation of new ideas are similar to the mechanisms that explain biological evolution in Darwinian terms. One of the leading expert of this model is Simonton (1999a, 1999b, 2005, 2007a, 2007b), who has expanded and redefined some of the main issues considered by the original model raised by Campbell (1960). Both, Campbell as Simonton suggest that there is no teleology in the creative process as well as discovering new ideas. It's for this reason they call their Blind Variation and Selective Retention model (BVSR). The attribute of blind is intended to highlight the lack of foresight in the production of variations: the inability to generative deliberately more adaptive variations. Thus, according to Campbell's theory (1960), for the production of genuinely new knowledge is essential to generate blind variations. Simonton (1999a, 1999b, 2005, 2007a, 2007b) takes the BVSR model and suggest throughout his studies and publications some modifications that extend the original model proposed by Campbell. In this sense, this article proposes to review some contributions and evidence presented by Simonton in the last decade. Then, five of the most crucial objections are examined (individual volition, social and cultural determinism, human rationality, expertise and human emotion). In order to achieve this goal, the criticisms made by some recognized authors in the area of psychology of creativity were considered, such as: Beghetto and Plucker (2007), Gardner (1999), Martindale (1999), Mumford and Antes (2007), Russ (1999), Sternberg (1999), Weisberg and Hass (2007). Finally, taking into account the ups and downs of creative ideas when confronted with reality, it is stressed Martindale's (1999) suggestion about whether it would be desirable to take into consideration the Lamarckian perspective of evolution rather than Darwinian perspective. Maybe the fact that some ideas are selected and changed over the time, it is not the result of a blind variation process but an artificial selection process according to the purposes or objectives set previously, either by the creators, either by the social group they belong to. In this sense, Csikszentmihalyi (1996/1998) has pointed out that creativity should be understand not only as an individual's process, but as a dialectical process that take place between the individual, the domain and the field.

Adaptación para Buenos Aires de la Escala de Autoeficacia General / Adaptation to Buenos Aires of the General Self-Efficacy Scale

El presente artículo tiene como objetivo principal informar acerca de las características psicométricas y los datos normativos de la Adaptación Argentina de la Escala de Autoeficacia General (EAG) de Jerusalem y Schwarzer (1992) a fin de poder contar con evidencias de validez y fiabilidad que permitan su uso idóneo en tareas de investigación. Incluye 10 ítemes con escalamiento tipo Likert de 4 puntos. La autoeficacia refiere a la percepción de los individuos para manejar adecuadamente una amplia gama de estresores de la vida cotidiana. Se analizaron los datos obtenidos de 292 sujetos, residentes en la Ciudad de Buenos Aires y alrededores (República Argentina). Se llevó a cabo un Análisis de Componentes Principales y se observó que, si bien emergen dos factores que explican el 44% de la variancia, el mayor porcentaje lo explica el primer factor con un 33%. En cuanto a la fiabilidad, los resultados indican una apropiada consistencia interna de los ítemes (α = .76) y, en relación a otras evidencias de validez, se obtuvieron correlaciones significativas con estrategias de afrontamiento al estrés de planeamiento (r= .459; p< .001) y actividad (r= .393; p< .001) y con medidas de locus de control externo (r= -.293; p< .001). Asimismo, se registraron diferencias en cuanto al sexo y la edad. En resumen, los resultados obtenidos indican evidencias de fiabilidad en términos de consistencia interna y de la validez de las puntuaciones obtenidas mediante la administración de la versión local de la EAG a residentes de Buenos Aires.

Self-efficacy is grounded in a larger theoretical framework known as social cognitive theory, which postulates that human achievement depends on interactions between one's behaviors, personal factors and environmental conditions (Bandura, 1986, 1997). Self-efficacy is understood as a construct that includes a stable feature or believing that a person has about his own ability to deal with a wide range of stressor of daily life. Moreover, self-efficacy beliefs work as an important set of proximal determinants of human motivation, affect, and action (Bandura,1989). The perception of self-efficacy has big impact on human adaptation and development. The General Self-Efficacy Scale was originally developed in Germany by Jerusalem and Schwarzer. At first they constructed a 20-item version and later as a reduced 10-item version (Jerusalem & Schwarzer, 1992; Schwarzer,1993). The GSES is a 10-item, 4-point Likert type scale. It was developed to assess a general sense of perceived self-efficacy in order to predict how people manage coping with daily difficulties and stressful events. The GSES, developed to measure this construct at the broadest level, has been adapted to many languages. The psychometric properties of this instrument areexamined among participants from 25 countries. Cronbach's alphas ranged from .73 to .91 and the findings suggest the global of the underlying construct. The goal of this article is to report psychometric properties (reliability, validity and normative data) of the Argentinean adaptation of the Jerusalem and Schwarzer General Self-Efficacy Scale (GSES). In the present study, the scale was applied to a sample of 292 participants of Buenos Aires (Ar gentina). We carried out a Principal Components Analysis. The first Eigen value was clearly higher than the others but the second Eigen value was a slight higher than unity (3.25; 1.16; .98; .86 y .75). One third (33%) of the variance is accounted for by first component, where as a second component would only account for 11% of the variance. The results show an appropriate internal consistency (.76) and significant correlations with planning (r= .417; p< .001) and activity strategies (r= .357; p< .001) of coping stress and a negative correlation with external locus of control (r = -.274; p< .001). In order to determine whether there were differences in scores by sex, age and educational level, we used the t Student and ANOVA tests. It was found a significant difference by sex (males: M = 33.6, SD = 3.24, and females: M = 32.6, SD = 3.43; t (287) = 2.814, p< .05), with similar average scores. Also, it was found a significant difference by age range (18 to 25: M = 32.4, SD = 2.9; 26 to 44: M = 32.9, DE = 3.2, and 45 to 65: M = 33.9, SD = 3.6; F (2, 286) = 5.142, p< .05) and education (Elementary school: M = 32.2, SD = 4.5; High School: M = 32.6, SD = 3.4; College Graduates: M = 33.9, SD = 3.0; F (2, 286) = 3.392, p < .035). But post hoc comparisons showed not significant differences between groups. According to this, differences found are not relevant and the perception of self-efficacy is similar for both sexes, age range or education level. Finally, all the results indicate evidences of reliability and validity of the Argentinean adaptation of the scale and guarantee it's usefulness in future studies.